Only prescribe opioids for short durations, advises Texas hospital group

Guidelines released to curb opioid abuse as Congress allocates $6 billion to fight

U.S. President Donald Trump signs a presidential memorandum after delivering remarks on combatting drug demand and the opioid crisis in the East Room of the White House in Washington, D.C., U.S., on Thursday, Oct. 26, 2017. Trump is instructing his administration to declare the opioid epidemic a public health emergency, a move could pave the way for a stronger federal response, allowing expanded access to telemedicine services and making grants available to those locked out of jobs because of the crisis. Photographer: Andrew Harrer/Bloomberg less

U.S. President Donald Trump signs a presidential memorandum after delivering remarks on combatting drug demand and the opioid crisis in the East Room of the White House in Washington, D.C., U.S., on Thursday, ... more

Photo: Andrew Harrer

Only prescribe opioids for short durations, advises Texas hospital group

In guidelines released Friday, the Texas Hospital Association calls on emergency departments to:

Write prescriptions for the shortest duration possible for patients being discharged and to only use short-acting opioids

Consult the state's Prescription Monitoring Program before writing opioid prescriptions

Put a system in place to contact the patient's primary opioid prescriber or primary care provider to notify them of the visit and the medications prescribed.

"Texas hospitals are just one piece of the complex health care equation," Sara Gonzalez, vice president, advocacy and public policy at the hospital association, said in a statement. "But working with our physician and insurance partners, we believe we can start to make a difference in stemming the tide of opioid misuse and abuse."

The association released the guidelines the same day Congress passed a two-year budget including $6 billion to deal with the crisis — $3 billion in fiscal year 2018 and another $3 billion in fiscal year 2019. That's in addition to existing opioid-related funding, including the $1 billion over fiscal years 2017 and 2018 that Congress dedicated to the opioid epidemic in the 21st Century Cures Act.

The opioid epidemic has led to hundreds of thousands of drug overdose deaths since the late 1990s. A 2016 study estimated the total economic burden of prescription opioid overdose, misuse, and addiction at $78.5 billion in 2013.

Texas doctors actually hand out far fewer addictive painkillers than most other states. A 2017 Centers for Disease Control and Prevention report per-capita opioid prescription rates in parts of the Midwest, Florida Gulf Coast, Appalachia and even the Pacific Northwest are more than double the rate recorded in Texas. Another 2017 CDC report found Texas recorded fewer opioid-related hospitalizations than nearly any other state.

Still, the THA guidelines emphasized the need to minimize the inappropriate use of opioids and opioid-related deaths in Texas. They noted the ER prescriptions for opioids account for approximately 45 percent of opioids diverted for non-medical use, even though such prescriptions represent just a fraction of those written nationally.

The voluntary guidelines also call for only the initial prescriber, primary-care provider or specialist to write new prescriptions for controlled substances patients report lost, destroyed or stolen; the development of a process for identifying patients at risk for developing a substance use disorder or with a substance use disorder; and the development of a protocol for treating pregnant and postpartum women at risk for developing a substance use disorder or who have an active substance use disorder.

Todd Ackerman covers medicine for the Houston Chronicle. Contact him at todd.ackerman@chron.com or on Twitter @ChronMed.